Hypoglycaemia link to myocardial damage bolstered
medwireNews: Elevated levels of high-sensitivity cardiac troponin T (hs-cTnT) are common in diabetes patients with a history of severe hypoglycaemia, show data from the ARIC study.
The researchers caution that they could only assess severe hypoglycaemia, requiring hospital treatment, and that such episodes were rare in this community-based study, affecting just 3% of the 2148 participants who had diabetes (average age=76 years).
However, 50% of these people had hs-cTnT levels above the 99% percentile for their gender (17 ng/L for women; 31 ng/L for men), compared with 18% of those without prior hypoglycaemia.
The finding is in line with previous reports of an increased risk of cardiovascular events among diabetes patients with a history of hypoglycaemia. And Elizabeth Selvin (Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA) and study co-authors note that the association is biologically plausible.
“By decreasing energy supply to the myocardium, hypoglycemia may result in myocardial damage and, consequently, elevated hs-cTnT, particularly among persons prone to ischemia”, they write in the Journal of the American College of Cardiology.
“As such, subclinical elevation in hs-cTnT could represent an intermediate step linking hypoglycemia to cardiovascular risk.”
Of note, the rate of elevated hs-cTnT was “extremely high” in patients with hypoglycaemia plus a history of coronary heart disease or heart failure, at 70%. The association between hypoglycaemia and hs-cTnT persisted after accounting for this, as well as age, gender and race, at a hazard ratio of 1.85, although it became nonsignificant after further adjustment for glycated haemoglobin levels and diabetes duration.
“Whether causal or a marker of risk, severe hypoglycemia should raise concern about subclinical as well as clinical [cardiovascular disease] risk”, the researchers conclude.
medwireNews is an independent medical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2016